Provider Demographics
NPI:1265005367
Name:FOSTER, JORDAN (DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CRUMP RD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1516
Mailing Address - Country:US
Mailing Address - Phone:610-241-2685
Mailing Address - Fax:877-732-7311
Practice Address - Street 1:4302 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4324
Practice Address - Country:US
Practice Address - Phone:610-241-2685
Practice Address - Fax:877-732-7311
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist